Abstract
Background
Early hemodynamic impairment frequently complicates myocardial injury, however, limited
data are present regarding its direct association with acute kidney injury (AKI) after
ST segment elevation myocardial infarction (STEMI) in patients who undergo primary percutaneous
coronary intervention (PCI). We evaluated the effect of acute hemodynamic derangement
on the risk of AKI among STEMI patients who undergo primary PCI.
Methods
We performed a retrospective analysis of 1656 consecutive patients admitted with the
diagnosis of STEMI between January 2008 and December 2014, and treated with primary
PCI. Medical records were reviewed for the presence of various clinical parameters
of hemodynamic derangement and for the occurrence of AKI.
Results
Mean age was 61 ± 13 and 1329 (80%) were men. AKI occurred in 168 patients (10%).
Patients with AKI were older, of female sex, with more comorbidities, had longer time
to reperfusion, and were more likely to have hemodynamic impairment including critical
state, congestive heart failure, life-threatening arrhythmias, and worse left ventricular
function (P < 0.001 for all). In a multivariate logistic regression model critical state (odds
ratio [OR], 3.33; 95% confidence interval [CI], 1.39-7.8; P = 0.006), reduced left ventricular ejection fraction (OR, 0.95; 95% CI, 0.92-0.99;
P = 0.03), congestive heart failure (OR, 2.34; 95% CI, 1.02-5.39; P = 0.04), and a trend for time to coronary reperfusion (OR, 1.01; 95% CI, 1.00-1.01;
P = 0.07) emerged as independent predictors of AKI.
Conclusions
Among STEMI patients who underwent primary PCI AKI should not be assumed to be solely
contrast-induced nephropathy and acute hemodynamic abnormalities should be considered.
Résumé
Introduction
La détérioration précoce de l’état hémodynamique complique fréquemment les lésions
myocardiques. Cependant, peu de données existent concernant son association directe
avec l’insuffisance rénale aiguë (IRA) après l’infarctus du myocarde avec sus-décalage
du segment ST (IM avec sus-décalage du segment ST) chez les patients qui subissent
l’intervention coronarienne percutanée (ICP) primaire. Nous avons évalué les conséquences
des perturbations hémodynamiques aiguës sur le risque d’IRA chez les patients ayant
subi un IM avec sus-décalage du segment ST qui subissent l’ICP primaire.
Méthodes
Nous avons réalisé une analyse rétrospective de 1656 patients consécutifs admis pour
un diagnostic d’IM avec sus-décalage du segment ST entre janvier 2008 et décembre
2014, et traités par ICP primaire. Nous avons passé en revue les dossiers médicaux
pour relever la présence de divers paramètres cliniques de perturbations hémodynamiques
et la survenue d’IRA.
Résultats
Les dossiers des patients dont l’âge moyen était de 61 ± 13 ans comptaient 1329 (80
%) hommes. L’IRA était survenue chez 168 patients (10 %). Les patients souffrant d’IRA
étaient plus âgés et de sexe féminin, avaient plus de comorbidités, avaient un délai
plus long avant la reperfusion et étaient plus susceptibles d’avoir une détérioration
hémodynamique, dont un état critique, une insuffisance cardiaque congestive, des arythmies
mettant la vie en danger et une plus mauvaise fonction ventriculaire gauche (P < 0,001 pour tous). Dans un modèle de régression logistique multivariée, l’état critique
(ratio d’incidence approché [RIA], 3,33; intervalle de confiance [IC] à 95 %, 1,39-7,8;
P = 0,006), la diminution de la fraction d’éjection ventriculaire gauche (RIA, 0,95;
IC à 95 %, 0,92-0,99; P = 0,03), l’insuffisance cardiaque congestive (RIA, 2,34; IC à 95 %, 1,02-5,39; P = 0,04) et la tendance à un délai de reperfusion coronarienne (RIA, 1,01; IC à 95
%, 1,00-1,01; P = 0,07) apparaissaient comme des prédicteurs indépendants de l’IRA.
Conclusions
Chez les patients atteints d’un IM avec sus-décalage du segment ST qui ont subi l’ICP
primaire, il ne faudrait pas supposer que l’IRA soit la seule néphropathie induite
par les produits de contraste, mais l’on devrait considérer les anomalies hémodynamiques
aiguës.
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Article info
Publication history
Published online: April 01, 2015
Accepted:
March 31,
2015
Received:
February 24,
2015
Footnotes
See editorial by Sood and Zieroth, pages 1221-1222 of this issue.
See page 1243 for disclosure information.
Identification
Copyright
© 2015 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
